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<title>Cat Blue Sheet</title>
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<body>
<div id="bodywidth">
<? include("header.inc");
include("leftmenu.inc");  ?>
<div id="wide2column">
<div class="bluebkgrnd">
<?php
include("db.php");
// Connect to the database server
dbConnect('kar_web1');   	// Use function in db.php to connect
$breeds = @mysql_query("SELECT * FROM petfinderBreeds WHERE animalType like '%Cat%'");
if (!$breeds) 
{
	echo("<p>Error performing breeds query: " . mysql_error() . "</p>");
	exit();
}
//   Loop through and write long Option_Block string containing database data
//   This is working on the result of the query from the petfinderBreeds table
$option_block2 = "<OPTION value=\"NULL\" SELECTED>-- Select a Breed --</OPTION>";
$option_block3 = "<OPTION value=\"NULL\" SELECTED>-- No Secondary Breed--</OPTION>";
while ($row = mysql_fetch_array($breeds)) 
{
		$breedName  = $row["breedName"];
		$option_block2 .= "<OPTION value=\"$breedName\">$breedName</OPTION>";  
		$option_block3 .= "<OPTION value=\"$breedName\">$breedName</OPTION>";  
}
?>
 <CENTER><H2>Cat Blue Sheet</H2>
 </CENTER><BR CLEAR=ALL>
<CENTER>
<TABLE WIDTH=550>
<TR>
  <TD>
Foster homes:
Please fill out this form to give the screener information about the  <B>cat/kitten (s)</B> you are fostering for KAR. Use the TAB key or your mouse to move between fields.&nbsp;&nbsp;Some browsers will send the form before you are done if you hit ENTER.</TD>
</TR>
<TR><TD>
</TABLE></CENTER>
<form method="post" action="submit_catblue.php">
  <p>
	<INPUT TYPE="hidden" NAME="success" VALUE="thanks4.htm">
	
	<STRONG>Your Name:</STRONG> <BR>
	<INPUT TYPE=TEXT NAME="v_name" SIZE=50>
	<BR>
	<BR>
	
	<STRONG>Home Phone:</STRONG><BR>
	<INPUT TYPE=TEXT NAME="home_phone" SIZE=20>
	<BR>
	<BR>
	
	<STRONG>Your Email Address:</STRONG>&nbsp;&nbsp;<FONT COLOR=#ff0000 SIZE="-1">(username@host.com)</FONT><BR>
	<INPUT TYPE=TEXT NAME="email" SIZE=50>
	<BR>
	<BR>

<div style="font-size:90%;padding:4px;border:thin solid black;background:#FFFFCC;width:250px;float:right">
<p>
<U>Adoption Fee Guidelines</U> 
<p><BR>
<TABLE>
<TR><TD width=50>Kittens</TD><TD width=150>under 6 months</TD>
<TD>$120</TD>
</TR>
<TR>
  <TD>&nbsp;</TD>
<TD>&nbsp;</TD>
<TD>&nbsp;</TD>
</TR>
<TR>
  <TD>Cats</TD>
<TD>6 months and older</TD>
<TD>$75</TD>
</TR>
<TR>
  <TD valign=top>&nbsp;</TD>
<TD>&nbsp;</TD>
<TD  valign=top>&nbsp;</TD>
</TR>
<TR><TD>SCC Cats</TD><TD>leave Fee field blank</TD><TD>&nbsp;</TD></TR>
</TABLE><BR>

Additional fees: <BR>
<LI>Cats micro-chipped, add $10 <BR>
<LI>Cats with Rabies vaccine, add $5<BR>&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;  (i.e. cats from Animal Services)<BR>
<LI>Unique and identifiable breed, add $30<BR><BR></p>
</div>

	<STRONG>Cat's Name:</STRONG> <BR>
	<INPUT TYPE=TEXT NAME="c_name" SIZE=30>
	<BR>
	<BR>
	<STRONG>Adoption Fee:</STRONG> (see guidelines at right)<BR>
	<INPUT TYPE=TEXT NAME="adoptFee" SIZE=10><BR><BR>

	<STRONG>Pet has been Microchipped</STRONG> &nbsp;&nbsp;&nbsp;&nbsp;<BR>
	<INPUT TYPE="radio" NAME="microchipped" VALUE="Yes">	Yes
	<INPUT TYPE="radio" NAME="microchipped" CHECKED VALUE="No">	No<BR><BR>

	<STRONG>Microchip Brand</STRONG><BR><input type="text" name="microchipBrand"  size=30>
<br /><BR></p>

	<STRONG>Microchip ID</STRONG><BR><input type="text" name="microchipID"  size=30 >
<br /><BR>

	<BR>
	
	<STRONG>How did the Animal Come into the Rescue?</STRONG><BR>
<INPUT TYPE="radio" NAME="inroad" VALUE="Stray">Stray
<INPUT TYPE="radio" NAME="inroad" VALUE="Owner_Relinquish">Owner Relinquish
<INPUT TYPE="radio" NAME="inroad" VALUE="Animal_Services">Animal Services 
<input type="radio" name="inroad" value="born_in_KAR" />Born in KAR
<INPUT TYPE="radio" NAME="inroad" VALUE="Other">Other<BR><BR>

<STRONG>Primary Breed</STRONG><BR>
<SELECT class="bodytext" id="primaryBreed" name="primaryBreed">
<?php echo "$option_block2"; ?>
</SELECT>
<br /><br /></p>

<STRONG>Secondary Breed</STRONG><BR>
<SELECT class="bodytext" id="secondaryBreed" name="secondaryBreed">
<?php echo "$option_block3"; ?>
</SELECT><BR><br /></p>

	<STRONG>Pet is a Mixed Breed (not a purebred)</STRONG>&nbsp;&nbsp;&nbsp;&nbsp;<BR>
	<INPUT TYPE="radio" NAME="mix" CHECKED VALUE="Yes">	Yes
	<INPUT TYPE="radio" NAME="mix" VALUE="No">	No<BR><BR>

	
	<STRONG>Gender:</STRONG><BR>
	<INPUT TYPE="radio" NAME="sex" VALUE="Male">
	Male
	<INPUT TYPE="radio" NAME="sex" VALUE="Female">
	Female<BR>
	<BR>
	
	<STRONG>Color(s):</STRONG> <BR>
	<INPUT TYPE=TEXT NAME="color" SIZE=50>
	<BR>
	<BR>
	
	<STRONG>Size when Grown (lbs):</STRONG><BR>
	<INPUT TYPE="radio" NAME="size" VALUE="Small">
	Small (Up to 7)
	<INPUT TYPE="radio" NAME="size" VALUE="Medium">
	Medium (8-11)
	<INPUT TYPE="radio" NAME="size" VALUE="Large">
	Large (12-18)
	<INPUT TYPE="radio" NAME="size" VALUE="Extra_Large">
	Extra Large (Over 18)<BR>
	<BR>
	
<STRONG>Approximate Date of Birth:</STRONG>&nbsp;&nbsp;<select NAME="DOB_month">
<option VALUE="01" <?php if (date(m)=='01') echo("SELECTED");?>>Jan
<option VALUE="02" <?php if (date(m)=='02') echo("SELECTED");?>>Feb
<option VALUE="03" <?php if (date(m)=='03') echo("SELECTED");?>>Mar
<option VALUE="04" <?php if (date(m)=='04') echo("SELECTED");?>>Apr
<option VALUE="05" <?php if (date(m)=='05') echo("SELECTED");?>>May
<option VALUE="06" <?php if (date(m)=='06') echo("SELECTED");?>>Jun
<option VALUE="07" <?php if (date(m)=='07') echo("SELECTED");?>>Jul
<option VALUE="08" <?php if (date(m)=='08') echo("SELECTED");?>>Aug
<option VALUE="09" <?php if (date(m)=='09') echo("SELECTED");?>>Sep
<option VALUE="10" <?php if (date(m)=='10') echo("SELECTED");?>>Oct
<option VALUE="11" <?php if (date(m)=='11') echo("SELECTED");?>>Nov
<option VALUE="12" <?php if (date(m)=='12') echo("SELECTED");?>>Dec
</select>&nbsp;&nbsp;
<select NAME="DOB_day">
<option VALUE="01" <?php if (date(d)=='01') echo("SELECTED");?>>1
<option VALUE="02" <?php if (date(d)=='02') echo("SELECTED");?>>2
<option VALUE="03" <?php if (date(d)=='03') echo("SELECTED");?>>3
<option VALUE="04" <?php if (date(d)=='04') echo("SELECTED");?>>4
<option VALUE="05" <?php if (date(d)=='05') echo("SELECTED");?>>5
<option VALUE="06" <?php if (date(d)=='06') echo("SELECTED");?>>6
<option VALUE="07" <?php if (date(d)=='07') echo("SELECTED");?>>7
<option VALUE="08" <?php if (date(d)=='08') echo("SELECTED");?>>8
<option VALUE="09" <?php if (date(d)=='09') echo("SELECTED");?>>9
<option VALUE="10" <?php if (date(d)=='10') echo("SELECTED");?>>10
<option VALUE="11" <?php if (date(d)=='11') echo("SELECTED");?>>11
<option VALUE="12" <?php if (date(d)=='12') echo("SELECTED");?>>12
<option VALUE="13" <?php if (date(d)=='13') echo("SELECTED");?>>13
<option VALUE="14" <?php if (date(d)=='14') echo("SELECTED");?>>14
<option VALUE="15" <?php if (date(d)=='15') echo("SELECTED");?>>15
<option VALUE="16" <?php if (date(d)=='16') echo("SELECTED");?>>16
<option VALUE="17" <?php if (date(d)=='17') echo("SELECTED");?>>17
<option VALUE="18" <?php if (date(d)=='18') echo("SELECTED");?>>18
<option VALUE="19" <?php if (date(d)=='19') echo("SELECTED");?>>19
<option VALUE="20" <?php if (date(d)=='20') echo("SELECTED");?>>20
<option VALUE="21" <?php if (date(d)=='21') echo("SELECTED");?>>21
<option VALUE="22" <?php if (date(d)=='22') echo("SELECTED");?>>22
<option VALUE="23" <?php if (date(d)=='23') echo("SELECTED");?>>23
<option VALUE="24" <?php if (date(d)=='24') echo("SELECTED");?>>24
<option VALUE="25" <?php if (date(d)=='25') echo("SELECTED");?>>25
<option VALUE="26" <?php if (date(d)=='26') echo("SELECTED");?>>26
<option VALUE="27" <?php if (date(d)=='27') echo("SELECTED");?>>27
<option VALUE="28" <?php if (date(d)=='28') echo("SELECTED");?>>28
<option VALUE="29" <?php if (date(d)=='29') echo("SELECTED");?>>29
<option VALUE="30" <?php if (date(d)=='30') echo("SELECTED");?>>30
<option VALUE="31" <?php if (date(d)=='31') echo("SELECTED");?>>31
</select>&nbsp;&nbsp;
<select NAME="DOB_year">
<option value="2011" <?php if (date(Y)=='2011') echo("SELECTED");?>>2011
<option value="2010" <?php if (date(Y)=='2010') echo("SELECTED");?>>2010
<option value="2009" <?php if (date(Y)=='2009') echo("SELECTED");?>>2009
<option value="2008" <?php if (date(Y)=='2008') echo("SELECTED");?>>2008
<option value="2007" <?php if (date(Y)=='2007') echo("SELECTED");?>>2007
<option value="2006" <?php if (date(Y)=='2006') echo("SELECTED");?>>2006
<option value="2005" <?php if (date(Y)=='2005') echo("SELECTED");?>>2005
<option value="2004">2004
<option value="2003">2003
<option value="2002">2002
<option value="2001">2001
<option value="2000">2000
<option value="1999">1999
<option value="1998">1998
<option value="1997">1997
<option value="1996">1996
<option value="1995">1995
<option value="1994">1994
<option value="1993">1993
<option value="1992">1992
<option value="1991">1991
<option value="1990">1990
<option value="1989">1989
<option value="1988">1988
<option value="1987">1987
</select><BR><BR>
	
  <STRONG>Spayed/Neutered:</STRONG><BR>
  <INPUT TYPE="radio" NAME="altered" VALUE="Yes">
	Yes
  <INPUT TYPE="radio" NAME="altered" VALUE="No">
	No<BR>
  <BR>

<STRONG>Up To date on Shots:</STRONG><BR>
  <INPUT TYPE="radio" NAME="shots" VALUE="Yes">
	Yes
  <INPUT TYPE="radio" NAME="shots" VALUE="No">
	No<BR>
  <BR>

	<STRONG>Pet has been vaccinated for Rabies</STRONG> &nbsp;&nbsp;&nbsp;&nbsp;<BR>
	<INPUT TYPE="radio" NAME="rabies" VALUE="Yes">	Yes
	<INPUT TYPE="radio" NAME="rabies" CHECKED VALUE="No">	No<BR><BR>
	
  <STRONG>Declawed:</STRONG><BR>
  <INPUT TYPE="radio" NAME="declawed" VALUE="Yes">
	Yes
  <INPUT TYPE="radio" NAME="declawed" VALUE="No">
	No<BR>
  <BR>
	
  <STRONG>Litter Trained:</STRONG><BR>
  <INPUT TYPE="radio" NAME="litter_trained" VALUE="Yes">
	Yes
  <INPUT TYPE="radio" NAME="litter_trained" VALUE="No">
	No<BR>
  <BR>
	<STRONG><u>Placement</u>:</STRONG><BR><BR>
  	  
<STRONG>1. Special Needs?</STRONG><BR>
<INPUT TYPE="radio" NAME="needs" VALUE="Yes">Yes
<INPUT NAME="needs" TYPE="radio" VALUE="No" checked="checked">
No&nbsp;&nbsp;
	<INPUT TYPE=TEXT NAME="c_needs" SIZE=50><BR><BR>
	  
<STRONG>2. Home without dogs?</STRONG><BR>
<INPUT TYPE="radio" NAME="dogs" VALUE="Yes">Yes
<INPUT NAME="dogs" TYPE="radio" VALUE="No" checked="checked">
No<BR><BR>

<STRONG>3. Home without other cats?</STRONG><BR>
<INPUT TYPE="radio" NAME="othercats" VALUE="Yes">Yes
<INPUT NAME="othercats" TYPE="radio" VALUE="No" checked="checked">
No<BR><BR>

<STRONG>4. Home without small children (&lt;5yrs)?</STRONG><BR>
<INPUT TYPE="radio" NAME="kids" VALUE="Yes">Yes
<INPUT NAME="kids" TYPE="radio" VALUE="No" checked="checked">
No<BR>
<BR>
   
	<STRONG>Bio for Petfinder:</STRONG><BR>
<textarea name="bio" cols=58 rows=8 wrap=physical></textarea><BR>
<BR>
	<INPUT NAME="ip" type="hidden" value="<?PHP echo $_SERVER['REMOTE_ADDR']; ?>" />
	<INPUT TYPE=SUBMIT VALUE="Submit Info">
	</FORM>
<BR>
</div>
</div>
<div class="clearit"></div>
<? include("footer.inc");  ?></div>
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